Middle Range Theory of Meaning in Nursing

Afza.Malik GDA

Nursing Care and Middle Range Theory

Middle Range Theory of Meaning in Nursing

Middle-Range Theory of Meaning,Major Concepts of Theories,Logo-therapy Method,Theory and Nursing Graduate and Under Graduate of Nursing.

Middle-Range Theory of Meaning

    The middle-range theory of meaning evolved out of the work of Victor E. Frankl (1984) who used the theory to administer to persons with problems of a psychological nature. 

    Patricia L. Starck (2003) used the theory for application to average human beings who are coping with the stresses of everyday life and significant life changing events. The theory can also be applied with groups and communities.

Major Concepts of Theories

    There are three major concepts in the theory. These concepts are life purpose, freedom to choose, and human suffering. Life purpose is defined as "that to which one may feel called to and to which one is dedicated" (Starck, 2003, p. 129). 

    Finding a purpose is related to the changing meaning in life. Free- dom to choose is "the process of selecting among options over which one has control" (Starck, p. 132). Human suffering is "a subjective experience that is unique to an individual and varies from simple discomfort to anguish and despair" (Starck, p. 133). 

    The relationship among the concepts "suggests that meaning is a journey toward life purpose with the freedom to choose one's path in spite of inevitable suffering" (Starck, p. 134). Starck (2003) identifies four instruments that have been used in research and practice to quantify meaning. 

    These instruments are: the Purpose in Life Test, Seeking of Noetic Goals Test, Meaning in Suffering Test, and the List of Values. Research has been conducted with hospice patients and families, breast cancer patients, persons with HIV/ AIDS, a physically disabled population with people who had a permanent spinal cord injury, and with persons in a nursing home (Starck, pp. 135-138). 

    These research studies focused on how the experience of intense suffering is related to the search for meaning and finding purpose in life.

Logo-therapy Method

    Logo-therapy is described as a method "to help persons separate themselves from their symptoms, to tap into the resources of their noetic dimension, and to arouse the dynamic power of the human spirit" and is a contrast to psychotherapy (Starck, 2003, p. 139). 

    Three logotherapeutic approaches are identified by Starck as useful for application of the theory of meaning to nursing practice. These are de reflection, paradoxical intention, and Socratic dialogue. 

    De reflection is the "act of de-emphasizing or ceasing to focus on a troublesome phenomenon, issue, or problem; it is putting this issue aside" (Starck, p. 139). It is believed that dereflection strengthens one's capacity for transcending the problem and finding a greater purpose. 

    Paradoxical intention is "intentionally acting the opposite to one's desired ends, thereby confronting one's fears and anxieties" (Starck, p. 140). Paradoxical intention distances one from the triggers of the problem, thus neutralizing the triggers and breaking the cycle of fear. 

    Socratic dialogue is a "conversation of questions and answers, probing deeply into existential issues such as one's values. It is a rhetorical debate to trigger a change in attitude, behavior or both" (Starck, p. 141). In the dialogue, there is a conversation punctuated by probing questions to facilitate a deeper level of awareness.

Theory and Nursing Graduate and Under Graduate of Nursing

    This theory should be a part of the education of undergraduate and graduate students to enhance the awareness of the importance of finding meaning and purpose in one's suffering. Teaching students to apply theory in practice will give direction to their care and advance their understanding of theory  based practice.

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